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Mardon AK, Chalmers KJ, Heathcote LC, Curtis LA, Freedman L, Malani R, Parker R, Neumann PB, Moseley GL, Leake HB. "I wish I knew then what I know now" - pain science education concepts important for female persistent pelvic pain: a reflexive thematic analysis. Pain 2024:00006396-990000000-00547. [PMID: 38452219 DOI: 10.1097/j.pain.0000000000003205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/18/2024] [Indexed: 03/09/2024]
Abstract
ABSTRACT Pain science education (PSE) provides people with an understanding of "how pain works" grounded in the biopsychosocial model of pain; it has been demonstrated to improve outcomes in musculoskeletal pain conditions. Preliminary evidence suggests PSE may be effective for female individuals with persistent pelvic pain, but how the content of PSE needs to be modified for this group remains to be determined. A reflexive thematic analysis of qualitative data was performed to identify PSE concepts that female individuals with persistent pelvic pain consider important and why. Twenty individual, semistructured interviews were conducted with adult females who had engaged with PSE and had self-identified as having "improved" pelvic pain. Most participants had been diagnosed with endometriosis (n = 16). Four themes were generated capturing PSE concepts considered important by female individuals with "improved" pelvic pain: (1) "A sensitised nervous system leads to overprotective pain" validated their pelvic pain as being real; (2) "Pain does not have to mean the body is damaged (although sometimes it does)" provided reassurance that pelvic pain does not mean their condition is worsening; (3) "How I think, feel, and 'see' my pain can make it worse" enabled participants to find optimal ways to manage their pain; and (4) "I can change my pain… slowly" provided hope that pelvic pain can improve and empowered them to pursue pain improvement as a viable goal. This study generated 4 PSE learning concepts that were important to female individuals with improved pelvic pain and may be incorporated into PSE curricula for female individuals with pelvic pain.
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Affiliation(s)
- Amelia K Mardon
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - K Jane Chalmers
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Lauren C Heathcote
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lee-Anne Curtis
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | | | - Rinkle Malani
- MGM School of Physiotherapy, Aurangabad, A Constituent Unit of MGMIHS, Maharashtra, India
| | - Romy Parker
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Patricia B Neumann
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
| | - Hayley B Leake
- IIMPACT in Health, Kaurna Country, University of South Australia, Adelaide, Australia
- The Pain Education Team Aspiring Learning (PETAL) Collaboration
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Leake HB, Moseley GL, Stanton TR, O'Hagan ET, Heathcote LC. What do patients value learning about pain? A mixed-methods survey on the relevance of target concepts after pain science education. Pain 2021; 162:2558-2568. [PMID: 33960326 DOI: 10.1097/j.pain.0000000000002244] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pain education is a popular treatment approach for persistent pain that involves learning a variety of concepts about pain (ie, target concepts), which is thought to be an important part of recovery. Yet, little is known about what patients value learning about pain. A mixed-methods survey was conducted to identify pain concepts that were valued by people with persistent pain who improved after a pain science education intervention. An online survey was distributed to 123 people who were treated for persistent pain with a pain science education approach; responses of participants who self-identified as "improved" were analysed. Open-ended survey questions were analysed using reflexive thematic analysis and close-ended questions were analysed for frequency of responses. Each question-type was analysed separately, before integration for complementarity. We analysed the data of 97 participants. We constructed 3 themes from the open-ended questions. Pain does not mean my body is damaged (theme 1) captured the importance of abandoning preexisting ideas that pain indicated damage. Thoughts, emotions and experiences affect pain (theme 2) captured the value of recognising multifactorial influences on pain. I can retrain my overprotective pain system (theme 3) captured the importance of conceptualising pain as a heightened protective response that could be lessened. Responses from close-ended questions confirmed that the target concepts represented by these themes are among those most valued, although divergence with the qualitative data suggests differences between patient and clinician language. These data offer patient-centred conceptualizations and language that could assist in further refining pain education interventions.
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Affiliation(s)
- Hayley B Leake
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Tasha R Stanton
- IIMPACT in Health, University of South Australia, Adelaide, South Australia, Australia
| | - Edel T O'Hagan
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren C Heathcote
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Scobbie L, Thomson K, Pollock A, Evans J. Goal adjustment by people living with long-term conditions: A scoping review of literature published from January 2007 to June 2018. Neuropsychol Rehabil 2021; 31:1314-1345. [PMID: 32525446 DOI: 10.1080/09602011.2020.1774397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Long-term health conditions can limit achievement of personal goals. We aimed to map and synthesize definitions of goal adjustment, theoretical underpinnings, associations with recovery and supportive interventions for adults with long-term conditions. We searched multiple databases (January 2007-June 2018) and identified peer-reviewed research relating to goal adjustment. Data were charted, mapped and synthesized using content analysis and descriptive summaries. Two stakeholder consultations informed the review. Ninety-one articles were included. A range of long-term conditions were represented including cancer (22%), stroke (12%) and mixed neurological conditions (8%). Goal adjustment was one available option when faced with unattainable goals; other options were goal disengagement and goal re-engagement. Most studies were quantitative (58%), reporting mainly positive associations between goal adjustment, disengagement, reengagement and recovery. The Dual Process Model, Goal Adjustment Model and Self-Regulation Theory were most cited underpinning models/theory. Five interventions were identified; only one (self-system therapy) was evaluated in a randomized controlled trial. Our review provides original and significant insights into goal adjustment definitions, theoretical underpinnings and association with recovery. Effective interventions to support goal adjustment, disengagement and reengagement are lacking. This research-practice gap warrants attention to ensure people with long-term conditions are optimally supported when facing unattainable goals.
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Affiliation(s)
- Lesley Scobbie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Alex Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Jonathan Evans
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
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Anokye R, Radavelli-Bagatini S, Bondonno CP, Sim M, Blekkenhorst LC, Connolly E, Bondonno NP, Schousboe JT, Woodman R, Zhu K, Szulc P, Jackson B, Dimmock J, Schlaich MP, Cox KL, Kiel DP, Lim WH, Devine A, Thompson PL, Gianoudis J, De Ross B, Daly RM, Hodgson JM, Lewis JR, Stanley M. Implementation, mechanisms of impact and key contextual factors involved in outcomes of the Modification of Diet, Exercise and Lifestyle (MODEL) randomised controlled trial in Australian adults: protocol for a mixed-method process evaluation. BMJ Open 2020; 10:e036395. [PMID: 33177130 PMCID: PMC7661373 DOI: 10.1136/bmjopen-2019-036395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The Modification of Diet, Exercise and Lifestyle (MODEL) study aims to examine the impact of providing visualisation and pictorial representation of advanced structural vascular disease (abdominal aortic calcification), on 'healthful' improvements to diet and lifestyle. This paper reports the protocol for the process evaluation for the MODEL study. METHODS AND ANALYSIS The overall aim of the process evaluation is to understand the processes that took place during participation in the MODEL study trial and which elements were effective or ineffective for influencing 'healthful' behavioural change, and possible ways of improvement to inform wider implementation strategies. A mixed-method approach will be employed with the use of structured questionnaires and semistructured in-depth interviews. All 200 participants enrolled in the trial will undertake the quantitative component of the study and maximum variation sampling will be used to select a subsample for the qualitative component. The sample size for the qualitative component will be determined based on analytical saturation. Interviews will be digitally recorded and transcribed verbatim. Qualitative data will be analysed thematically and reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. ETHICS AND DISSEMINATION The MODEL study process evaluation has received approval from Edith Cowan University Human Research Ethics Committee (Project Number: 20513 HODGSON). Written informed consent will be obtained from all participants before they are included in the study. The study results will be shared with the individuals and institutions associated with this study as well as academic audiences through peer-reviewed publication and probable presentation at conferences. TRIAL REGISTRATION NUMBER ACTRN12618001087246.
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Affiliation(s)
- Reindolf Anokye
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Simone Radavelli-Bagatini
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Catherine P Bondonno
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Marc Sim
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Emma Connolly
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Nicola P Bondonno
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and Health Partners Institute and Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Pawel Szulc
- INSERM UMR1033, University of Lyon, Lyon, France
| | - Ben Jackson
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - James Dimmock
- Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
| | - Markus P Schlaich
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Kay L Cox
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew Senior Life, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Wai H Lim
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Amanda Devine
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Peter L Thompson
- Department of Cardiology, University of Western Australia, Perth, Western Australia, Australia
| | - Jenny Gianoudis
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Victoria, Australia
| | - Belinda De Ross
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Victoria, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Victoria, Australia
| | - Jonathan M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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Sweeney AMT, McCabe C, Flurey CA, Robson JC, Berry A, Richards P, Ndosi M. The patient perspective of nurse-led care in early rheumatoid arthritis: A systematic review of qualitative studies with thematic analysis. J Clin Nurs 2020; 30:145-160. [PMID: 33125809 DOI: 10.1111/jocn.15531] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Management of rheumatoid arthritis has changed dramatically over the last decade and is characterised by early start of intensive treatment and tight monitoring of disease activity until remission. The role of nurse-led care at early stage of disease is not well understood. AIMS To develop an understanding of rheumatology nurse-led care from the perspective of patients with early rheumatoid arthritis. METHODS A systematic review of qualitative studies, reported in line with PRISMA checklist. In March 2019, the following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO and OpenGrey. Studies were included if they: included adults with rheumatoid arthritis; were qualitative studies with data on patients' perspectives of nurse-led care; and published in peer-reviewed journals, in English, between 2010-2019. Due to few studies in early rheumatoid arthritis, inclusion was extended to adults with established rheumatoid arthritis. Two reviewers screened abstracts and full texts. Joanna Briggs Institute Critical Appraisal Tool was used for quality assessment. Thematic synthesis was conducted according to the framework of Thomas and Harden (2008). RESULTS The search identified 1034 records. After screening and assessing for eligibility, eight qualitative studies were included in the review (133 patients). Three themes were identified from the synthesis. Nurse-led care was seen to provide professional expertise in planning and delivery of care. A person-centred approach was used combined with good communication skills, thus creating a positive therapeutic environment. Nurse-led care was described as providing a sense of empowerment and psychological support. CONCLUSION Patients with rheumatoid arthritis are supportive of nurse-led care. They value its professionalism and person-centred approach which provide a sense of security and confidence. RELEVANCE TO CLINICAL PRACTICE The findings outline ingredients of nurse-led care that are important to patients. These can inform nurses' professional development plans, service improvement and the competence framework for rheumatology nursing.
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Affiliation(s)
- Anne-Marie Tetsche Sweeney
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,The Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Candy McCabe
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,Dorothy House Hospice Care, Winsley, UK.,Florence Nightingale Foundation, London, UK
| | - Caroline A Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Joanna C Robson
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,The Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Alice Berry
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,The Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Pamela Richards
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,The Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Mwidimi Ndosi
- Department of Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.,The Academic Rheumatology Unit, Bristol Royal Infirmary, University Hospitals Bristol NHS Trust, Bristol, UK
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6
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Ho LYW, Chin KCW, Fung CYY, Lai CKY. Validation of the Chinese Non-pharmacological Therapy Experience Scale in persons with intellectual disability. Nurs Open 2020; 7:390-397. [PMID: 31871724 PMCID: PMC6917964 DOI: 10.1002/nop2.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/25/2019] [Indexed: 11/08/2022] Open
Abstract
Aim To validate the 4- and 7-point Chinese Non-pharmacological Therapy Experience Scales and test the psychometric properties of the scales on persons with intellectual disability. Design A validation study. Methods Sixty-seven persons with intellectual disability were recruited from six hostels or centres for persons with intellectual disability in Hong Kong. A total of 1,163 and 1,161 observations were collected by the trained observers with the 4-point and 7-point scales, respectively. The floor and ceiling effects, inter-rater reliability, internal consistency, responsiveness of both scales and the scale equivalence were examined. Results The Cronbach's α of the 4- and 7-point scales was .762 and .797, respectively. The correlation between the two scales was 0.906. The inter-rater reliability of the 4- and 7-point scales was 0.774 and 0.835, respectively. Neither scale had the floor or ceiling effects. The effect size of the 7-point scale was consistently higher than that of the 4-point scale.
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Affiliation(s)
- Lily Yuen Wah Ho
- School of NursingThe Hong Kong Polytechnic UniversityKowloonHong Kong
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Arewasikporn A, Roepke AM, Turner AP, Alschuler KN, Williams RM, Amtmann D, Molton IR. Goal Pursuit, Goal Adjustment, and Pain in Middle-Aged Adults Aging With Physical Disability. J Aging Health 2019; 31:214S-240S. [PMID: 31718416 DOI: 10.1177/0898264319827142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Aging with physical disability disrupts one's ability to achieve valued goals due to changes in symptoms and function. It is unclear how to cope optimally in this context. This study examined whether two possible strategies-tenacious goal pursuit (TGP) and flexible goal adjustment (FGA)-were associated with reduced pain interference and depressive symptoms and greater well-being, and protected against pain intensity, and FGA was more protective with increasing age and worse physical function. Method: Middle-aged adults with muscular dystrophy, multiple sclerosis, post-polio syndrome, or spinal cord injury (N = 874; MAGE = 58.3 years, range = 46-68; MDISEASEDURATION = 26.2 years, range = 2-67) completed two questionnaires, a year apart. Results: TGP and FGA use was associated with greater well-being. FGA use predicted decreased depressive symptoms. Concurrent use of both predicted decreased pain interference. Discussion: Adults with disability employ a variety of goal management strategies. Findings support TGP and FGA as potential intervention targets for healthy aging with disabilities.
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Affiliation(s)
- Anne Arewasikporn
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Ann Marie Roepke
- Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Aaron P Turner
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | | | - Rhonda M Williams
- University of Washington School of Medicine, Seattle, USA.,Veteran Affairs Puget Sound Health Care System, Seattle, WA, USA
| | - Dagmar Amtmann
- University of Washington School of Medicine, Seattle, USA
| | - Ivan R Molton
- University of Washington School of Medicine, Seattle, USA
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Frost J, Wingham J, Britten N, Greaves C, Abraham C, Warren FC, Jolly K, Doherty PJ, Miles J, Singh SJ, Paul K, Taylor R, Dalal H. Home-based rehabilitation for heart failure with reduced ejection fraction: mixed methods process evaluation of the REACH-HF multicentre randomised controlled trial. BMJ Open 2019; 9:e026039. [PMID: 31377692 PMCID: PMC6686989 DOI: 10.1136/bmjopen-2018-026039] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To identify and explore change processes explaining the effects of the Rehabilitation Enablement in Chronic Heart Failure (REACH-HF) intervention taking account of reach, amount of intervention received, delivery fidelity and patient and caregiver perspectives. DESIGN Mixed methods process evaluation parallel to a randomised controlled trial using data from the intervention group (REACH-HF plus usual care). SETTING Four centres in the UK (Birmingham, Cornwall, Gwent and York). PARTICIPANTS People with heart failure with reduced ejection fraction (HFrEF) and their caregivers. METHODS The REACH-HF intervention consisted of a self-help manual for patients with HFrEF and caregivers facilitated over 12 weeks by trained healthcare professionals. The process evaluation used multimodal mixed methods analysis. Data consisted of audio recorded intervention sessions; demographic data; intervention fidelity scores for intervention group participants (107 patients and 53 caregivers); qualitative interviews at 4 and 12 months with a sample of 19 patients and 17 caregivers. OUTCOME MEASURES Quantitative data: intervention fidelity and number, frequency and duration of intervention sessions received. Qualitative data: experiences and perspectives of intervention participants and caregivers. RESULTS Intervention session attendance with facilitators was high. Fidelity scores were indicative of adequate quality of REACH-HF intervention delivery, although indicating scope for improvement in several areas. Intervention effectiveness was contingent on matching the intervention implementation to the concerns, beliefs and goals of participants. Behaviour change was sustained when shared meaning was established. Respondents' comorbidities, socio-economic circumstances and existing networks of support also affected changes in health-related quality of life. CONCLUSIONS By combining longitudinal mixed methods data, the essential ingredients of complex interventions can be better identified, interrogated and tested. This can maximise the clinical application of research findings and enhance the capacity of multidisciplinary and multisite teams to implement the intervention. TRIAL REGISTRATION NUMBER ISRCTN25032672; Pre-results.
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Affiliation(s)
- Julia Frost
- Institute of Health Research, University of Exeter, Exeter, UK
| | | | - Nicky Britten
- Institute of Health Research, University of Exeter, Exeter, UK
- PenCLAHRC—The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter, Exeter, UK
| | - Colin Greaves
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Charles Abraham
- School of Pscyhological Sciences, University of Melbourne, Melbourne, Victoria, Australia
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Fiona C Warren
- Collaboration for Academic Primary Care, University of Exeter, Exeter, UK
| | - Kate Jolly
- University of Birmingham, Institute of Applied Health Research, Birmingham, UK
| | | | - Jackie Miles
- Department of innovation and Research, Aneurin Bevan Health Board, Newport, UK
| | - Sally J Singh
- Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kevin Paul
- Patient and Public Involvement Group, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Rod Taylor
- Institute of Health Research, University of Exeter, Exeter, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hasnain Dalal
- Teaching and Research, Royal Cornwall Hospitals NHS Trust, Truro, UK
- Primary Care, University of Exeter Medical School, Truro, UK
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Bech B, Primdahl J, van Tubergen A, Voshaar M, Zangi HA, Barbosa L, Boström C, Boteva B, Carubbi F, Fayet F, Ferreira RJO, Hoeper K, Kocher A, Kukkurainen ML, Lion V, Minnock P, Moretti A, Ndosi M, Pavic Nikolic M, Schirmer M, Smucrova H, de la Torre-Aboki J, Waite-Jones J, van Eijk-Hustings Y. 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 2019; 79:61-68. [DOI: 10.1136/annrheumdis-2019-215458] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/08/2019] [Accepted: 06/23/2019] [Indexed: 12/14/2022]
Abstract
To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.
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10
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Geuens J, Geurts L, Swinnen TW, Westhovens R, Vanden Abeele V. Mobile Health Features Supporting Self-Management Behavior in Patients With Chronic Arthritis: Mixed-Methods Approach on Patient Preferences. JMIR Mhealth Uhealth 2019; 7:e12535. [PMID: 30907737 PMCID: PMC6452281 DOI: 10.2196/12535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023] Open
Abstract
Background Patients with chronic arthritis (CA) ideally apply self-management behaviors between consultations. This enduring, tedious task of keeping track of disease-related parameters, adhering to medication schemes, and engaging in physical therapy may be supported by using a mobile health (mHealth) app. However, further research is needed to determine which self-management features are valued most by adult patients with CA patients. Objective The aim of this study was to determine the preference of features for an mHealth app to support self-management behavior in patients with CA. In addition, we aimed to explore the motives behind these ratings. Methods A mixed-methods approach was used to gather information from 31 adult patients (14 females), aged 23 to 71 years (mean 51 [SD 12.16]), with CA. Structured interviews were conducted to gather data pertaining to preferences of app features. Interviews were analyzed qualitatively, whereas ratings for each of the 28 features studied were analyzed quantitatively. Results In general, patients with CA favored the use of features pertaining to supporting active and direct disease management, (eg, medication intake and detecting and alarming of bad posture), helping them to keep a close watch on their disease status and inform their health care professional (eg, providing a means to log and report disease-related data) and receiving personalized information (eg, offering tailored information based on the patient’s health data). Patients strongly disliked features that provide a means of social interaction or provide incentivization for disease-related actions (eg, being able to compare yourself with other patients, cooperating toward a common goal, and receiving encouragement from friends and/or family). Driving these evaluations is the finding that every patient with CA hurts in his/her own way, the way the disease unfolds over time and manifests itself in the patient and social environment is different for every patient, and patients with CA are well aware of this. Conclusions We have offered an insight into how patients with CA favor mHealth features for self-management apps. The results of this research can inform the design and development of prospective self-management apps for patients with CA.
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Affiliation(s)
- Jonas Geuens
- e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Luc Geurts
- e-Media Research Lab, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Thijs W Swinnen
- Division of Rheumatology, Universitaire Ziekenhuizen Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Rene Westhovens
- Division of Rheumatology, Universitaire Ziekenhuizen Gasthuisberg, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Katholieke Universiteit Leuven, Leuven, Belgium
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Haydon MD, Stanton AL, Ganz PA, Bower JE. Goal disturbance in early-stage breast cancer survivors. J Psychosoc Oncol 2019; 37:478-493. [PMID: 30681035 DOI: 10.1080/07347332.2018.1563265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Cancer-related goal disturbance can influence long-term outcomes in cancer patients and survivors; however, few studies have examined the factors that contribute to goal disturbance in early survivorship. DESIGN The current study examined the relationships between demographic variables, cancer- and treatment-related factors, and behavioral and psychological symptoms (i.e., fatigue, pain, cognitive complaints, depressive symptoms, and anxiety) and goal disturbance in breast cancer survivors 1 year after treatment completion. METHODS Women diagnosed with early-stage breast cancer (n = 171) completed assessments following primary treatment (i.e., surgery, radiation, and chemotherapy) and again 6 months and 1 year later. We focused on the 1-year post-treatment assessment when participants were asked if they had experienced a cancer-related goal disturbance. FINDINGS Approximately, 27% of women reported a cancer-related goal disturbance. Analyses indicated that both receipt of chemotherapy and behavioral and psychological symptoms-analyzed as a composite score and individually-were associated with a higher probability of reporting a goal disturbance. CONCLUSIONS Chemotherapy and behavioral and psychological symptoms were unique correlates of goal disturbance, suggesting that the impact of chemotherapy extends beyond its influence on persistent symptoms. IMPLICATIONS Elucidating factors that inhibit the pursuit of meaningful activities in early survivorship is critically important to understanding the long-term psychosocial impacts of cancer diagnosis and treatment.
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Affiliation(s)
- Marcie D Haydon
- a Department of Psychology , University of California, Los Angeles, (UCLA) , Los Angeles , California , USA
| | - Annette L Stanton
- a Department of Psychology , University of California, Los Angeles, (UCLA) , Los Angeles , California , USA.,b Department of Psychiatry and Biobehavioral Sciences , UCLA , Los Angeles , California , USA.,c Jonsson Comprehensive Cancer Center, UCLA , Los Angeles , California , USA.,d Cousins Center for Psychoneuroimmunology, UCLA , Los Angeles , California , USA
| | - Patricia A Ganz
- c Jonsson Comprehensive Cancer Center, UCLA , Los Angeles , California , USA.,e Schools of Medicine and Public Health , UCLA , Los Angeles , California , USA
| | - Julienne E Bower
- a Department of Psychology , University of California, Los Angeles, (UCLA) , Los Angeles , California , USA.,b Department of Psychiatry and Biobehavioral Sciences , UCLA , Los Angeles , California , USA.,c Jonsson Comprehensive Cancer Center, UCLA , Los Angeles , California , USA.,d Cousins Center for Psychoneuroimmunology, UCLA , Los Angeles , California , USA
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Arends RY, Bode C, Taal E, Van de Laar MAFJ. A goal management intervention for patients with polyarthritis and elevated levels of depressive symptoms: a quasiexperimental study. Disabil Rehabil 2018; 42:957-966. [PMID: 30453793 DOI: 10.1080/09638288.2018.1513086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis.Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasiexperimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes.Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group.Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed.Implications for rehabilitationPeople with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation.Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis.The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals.The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up.
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Affiliation(s)
- Roos Y Arends
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Erik Taal
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Mart A F J Van de Laar
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.,Department for Rheumatology, Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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